Elias Mossialos is Brian Abel-Smith Professor of Health Policy, head of the Department of Health Policy and director of LSE Health. He is also the co-director of the European Observatory on Health Systems and Policies. He has served as an advisor to several agencies including the WHO, the European Parliament, the European Commission, the World Bank and health insurance funds in Austria, Croatia and Hungary. Photo: LSE

“The coronavirus knows no borders,” said Elias Mossialos, a professor and head of the Department of Health Policy at London School of Economics and Political Science in a recent interview with CSST. To curb the pandemic, Mossialos called for global solidarity and cross-border efforts instead of protectionism, xenophobia and racist discrimination.

CSST: The World Health Organization has declared the coronavirus outbreak a global pandemic. How prepared are governments for such a pandemic?

Mossialos: Unfortunately, many governments were not adequately prepared for this pandemic. While some countries were more prepared than others, in today’s globalized world, no country can be adequately prepared unless all countries are. Not only could preparedness investments have avoided disease and death, but prevention and preparedness are less expensive compared to responding to an epidemic/pandemic later: The Coalition for Epidemic Preparedness Innovation (CEPI) estimates that the annual global cost of moderately severe to severe pandemics is about $570 billion.

Some countries were more prepared for this pandemic than others, but no country has prepared adequately for the immense pressure that this pandemic will put on health systems. Countries across the globe, including high-income ones, do not have the ICU capacity, ventilators and other infrastructure they need to handle huge surges in seriously ill patients.

Thus far in the pandemic, there has been an unfortunate lack of global solidarity, which has prevented us from implementing coordinated and effective outbreak responses. Viruses and other pathogens do not respect borders, so efforts to prevent and delay their spread must also cut across borders.

CSST: Some say the best cure for a pandemic is greater global cooperation, do you agree?

Mossialos: In order to combat this pandemic, collaboration, cooperation and solidarity across the globe will be key. While existing initiatives, such as the World Bank Pandemic Emergency Financing Facility (PEF) are commendable, alone they are inadequate for tackling a pandemic. Cooperation efforts must therefore go beyond PEF to develop a much more comprehensive insurance policy that can release funds in a timely fashion.

In addition to the introduction of global insurance, greater solidarity is needed to effectively tackle the challenges posed by this disease. An increase in solidarity is required not only between different countries, but also between scientific experts, policymakers and the public.

In the past month, we have seen unfortunate incidences where there has been a gross lack of solidarity: It has been reported that the US offered funds to CureVac in an attempt to move its research on a coronavirus vaccine from Germany to the US. While a US official claims that any vaccine solution found would be shared with the rest of the world, this action exemplifies the lack of trust and solidarity that has been seen several times so far in this fight against COVID-19. In the European Union, countries have been slow to offer joint approaches to combat the coronavirus, and up until the recent closure of the EU outer boarder, most of the efforts to contain and/or delay the disease have been domestically run.

A huge lesson from the past few months has been the important role of scientific experts and the vital need for policymakers and the public to interact with and listen to them. These epidemiologists, economists, virologists, etc. will be key to guiding us all towards the best responses and mechanisms to fight against the spread of this disease.

CSST: Given the varying degrees of their preparedness and capacity to fight the pandemic, what are your suggestions for countries to better assist each other?

Mossialos: In this next phase of the pandemic, we need to leave behind political tiffs and begin cooperating globally. Some of the hardest hit countries, such as China and Italy, will inevitably learn lessons as they address this disease, and these will likely be things that the rest of the world can benefit from.

Even rich countries with health systems considered to be strong, such as France and the UK, are struggling to contain and control this virus. The pandemic could become much more acute as it continues to spread to low- and lower-middle-income countries (LMICs) where health systems are in earlier stages of development and strengthening. Higher-income countries should support a fund that supports LMICs in their efforts towards combatting coronavirus.

CSST: While some see it as a wakeup call for those dismissing the need for greater global collaboration, the pandemic is also fueling protectionism, xenophobia and discrimination. How to address this?

Mossialos: Over the last three months, there have been numerous accounts of xenophobia and discrimination against East Asians, and some of this has even been fuelled by government leaders. The UK has seen a rise in cases of racist violent assault against East Asians, and even more instances of verbally racist acts and discrimination against this population. In Europe, some right-wing leaders have not only discriminated against Asians, but also blamed immigrants and refugees of non-Asian descent. US republican leaders, including President Trump, have also referred to the disease as the “Chinese Virus,” directly disobeying recommendations by the WHO to avoid terms like these.

Government leadership must take charge in preventing and eliminating protectionism, xenophobia and racial discrimination in their countries through utilizing appropriate terminology, making evidence-based policy decisions and educating the public about how the disease is spread as well as who can catch and transmit it.

CSST: What strategy do you suggest for preventing and controlling COVID-19?

Mossialos: Effective strategies to decrease the spread of the disease and gain control over the virus may include investment into new technologies and resources that would aid in prevention and treatment efforts. Firstly, we need global commitment to and investment in the development of a vaccine. As any vaccine candidate will require safety and efficacy tests, we are unlikely to have one available for another twelve months.

In the meantime, other novel technologies and approaches can be utilized to control the spread of illness. Investments could be made to develop longer-lasting antiseptics that could be used in hospitals and other public spaces; larger stocks of medical equipment, ventilators, PPEs, etc. should be purchased to support healthcare staff and health center capacity; and increased use of robotics, AI and IT systems and the different ways in which they can increase healthcare capacity, surveillance and healthcare treatment should be explored.

CSST: Many previous experiences have shown that the R&D of vaccines is profit-driven. Manufacturers may abandon their R&D if the vaccines turn out to be non-profitable. How to incentivize the development of COVID-19 vaccines?

Mossialos: CEPI estimates that at least $2 billion is necessary to bring a COVID-19 vaccine candidate through to licensure and broader use. Because vaccine manufacturing is driven by profit, it is necessary that R&D is incentivized at all stages until completion and delivery of the vaccine—even in the case that the coronavirus situation falls relatively under control.

In previous epidemics, we have seen that after large investments into research for vaccines, efforts stall once government priorities shift and manufacturers realize a final product won’t produce profits. Funding incentive mechanisms, such as one I have previously proposed—the options market for antibiotics and vaccines, which would provide both push incentives to encourage research into vaccines as well as pull mechanisms which reward the completion of development—should be considered for the coronavirus situation.

The Options for Vaccines and the Options Market for Antibiotics models are both based on principles of call options in equity markets. In these market call options an investor pays a fixed price to buy the right to purchase a share of stock once the stock price reaches a pre-defined strike price. Thus, for the chance to profit later, the investor pays a premium now. This promotes risk sharing between the investor and the developer since the investor profit is not guaranteed, and in the case that the investor does profit, it will come at the seller’s expense. Adopting a similar method for COVID-19 R&D could serve as an effective way to encourage early investment and risk sharing while also maintaining incentives for manufacturers to bring new medicines—such as a vaccine for COVID-19—to market.

CSST: In addition to prompt reporting and sharing of genomic sequences like China has done, what else can governments and national leaders do to build trust and cooperation domestically and internationally?

Mossialos: A key to increasing trust will be continued transparency among national government and international governmental organization leadership. Alongside transparency and regular updates on case numbers and health system capacity, governments and international organizations can show broader cooperation through exchange of information and best practices. The fight against COVID-19 necessitates global collaborative efforts, and countries can work together to determine what’s effective and what’s ineffective in this fight.

Until a vaccine is readily available and affordable, it is likely that physical distancing—referred to more commonly as social distancing—practices may need to be maintained in order to suppress disease transmission. These practices are difficult, and the enforcement of physical distancing policies may have social, ethical and economic costs. The global community must thus do everything in their power to develop a safe, effective and affordable COVID-19 vaccine in the quickest way possible while also ensuring quality.

While we await the development of a vaccine, several things must be done to prevent something like this from happening again in the future. In almost all parts of the world, public health has been severely underfunded. It’s clear to see what a mistake this lack of interest in and funding for public health has been: The coronavirus has taken advantage of our weak public health systems and prevention efforts and has spread rapidly throughout the globe. Going forward, governments must learn from this mistake and dedicate more resources towards their public health and prevention systems.

Novel approaches can be utilized against this novel infection, and joint investment into new technologies should be considered. There are opportunities for robots and AI to be deployed to the frontlines of this battle. These technologies could be used to aid in the continuity of daily life and socioeconomic functions, including disinfection, delivery of food and supplies, telecommunication, diagnosis and screening, and surgical and intensive care functions.